The long term career goal of this proposal is for the applicant to become an independent researcher and to gain training in designing and implementing studies that are relevant to populations and maternal and newborn health policy in sub-Saharan Africa. The immediate goal is to complete the proposed training program that includes the following objectives: 1) to acquire research skills in advanced qualitative and quantitative methods in order to conduct surveys, focus groups, and participant-observation studies in sub-Saharan Africa;2) to translate research findings into clinical practice protocols in sub-Saharan Africa;3) to establish relationships in sub-Saharan Africa in order to influence maternal-newborn health policy;and 4) to secure an independent tenure-track faculty position. Key Elements of Career Plan The career plan focuses on coursework at the University of Ghana (UG), University of Michigan (UM) and the University of North Carolina (UNC) with participation and presentations at seminars and scientific meetings. The faculty mentors, Drs. Tim Johnson (UM) and Richard Adanu (UG), leading experts in the field of Ghanaian women's reproductive health, will be involved in all aspects of carrying out the research and training plan. The research project will allow for experiences in conducting community based research, feasibility studies in low resource clinic settings, and the use of quasi-experimental design in examining program effectiveness. Research Project Drawing on a sample from one Ghanaian District Hospital in the Ashanti Region, the overall aims of the research are to: 1) modify the Home-Based Life Saving Skills (HBLSS) program for use by skilled midwives (HBLSS-M) in a Ghanaian clinical setting;2) establish the feasibility of the HBLSS-M in Ghana;and 3) determine whether exposure to the HBLSS-M increases Ghanaian women's use of skilled birth attendants for delivery and improves birth outcomes. To meet Aim 1, a community participation strategy with a focus group design will be used to develop the HBLSS-M and to get buy-in from the community being served. To meet Aim 2, five skilled midwives will be trained to deliver the HBLSS-M and feasibility will be assessed. To meet Aim 3, a two-group comparison design (92 participants in each group) will be used to determine whether the HBLSS- M, delivered by 10 midwives produces a greater number of deliveries with professional midwives and improves birth outcomes. It is hypothesized that child-bearing women who receive the HBLSS-M program will be more likely to deliver with skilled midwives and experience improved birth outcomes than the child-bearing women in the comparison group. Environment As one of the world's foremost research institutions, the UM provides an exceptionally rich environment for nursing research. The proposed research training plan is congruent with the UM international initiatives spearheaded from the President's Office. For more than 20 years, the UM has sought mutual engagement with our partners from Ghana. The UG is the oldest and largest of the seven Ghanaian public universities. It is by far the most prestigious university in West Africa. It was founded in 1948 as the University College of the Gold Coast and was originally an affiliate college of the University of London, which supervised its academic programs and awarded degrees. It gained full university status in 1961, and now has nearly 30,000 students. After completion of the proposed five-year training program, the applicant will be well positioned to conduct interdisciplinary, high-impact research that conveys the role of professional midwives in sub-Saharan Africa. PUBLIC HEALTH RELEVANCE: This career development plan provides coursework and mentored experiences to acquire additional skills for an independent global health research career. The research project develops a modified version of the Home-Based Life Saving Skills (HBLSS-M), tests its feasibility in a Ghanaian setting and examines whether exposure to the HBLSS-M increases Ghanaian women's use of skilled birth attendants for delivery and improves birth outcomes.